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Research ArticleAloe vera Gel: Effective Therapeutic Agent againstMultidrug-Resistant Pseudomonas aeruginosa IsolatesRecovered from Burn Wound Infections

Mehdi Goudarzi,1 Maryam Fazeli,2 Mehdi Azad,3

Sima Sadat Seyedjavadi,4 and Reza Mousavi5

1Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran 1985717443, Iran2WHO Collaborating Center for Reference and Research on Rabies, Pasteur Institute of Iran, Tehran 1316943551, Iran3Department ofMedical Laboratory Sciences, School of Paramedicine, Qazvin University of Medical Sciences, Qazvin 1651135779, Iran4Department of Medical Mycology, Pasteur Institute of Iran, Tehran 1316943551, Iran5Department of Medical Laboratory Sciences, School of Paramedicine, Shahid Beheshti University of Medical Sciences,Tehran 1985717443, Iran

Correspondence should be addressed to Sima Sadat Seyedjavadi; sima [email protected]

Received 7 May 2015; Revised 28 June 2015; Accepted 12 July 2015

Academic Editor: Athanassios Tsakris

Copyright © 2015 Mehdi Goudarzi et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

Objective.Aloe vera is an herbal medicinal plant with biological activities, such as antimicrobial, anticancer, anti-inflammatory, andantidiabetic ones, and immunomodulatory properties.The purpose of this study was investigation of in vitro antimicrobial activityof A. vera gel against multidrug-resistant (MDR) Pseudomonas aeruginosa isolated from patients with burn wound infections.Methods. During a 6-month study, 140 clinical isolates of P. aeruginosa were collected from patients admitted to the burn wardsof a hospital in Tehran, Iran. Antimicrobial susceptibility test was carried out against the pathogens using the A. vera gel andantibiotics (imipenem, gentamicin, and ciprofloxacin). Results. The antibiogram revealed that 47 (33.6%) of all isolates were MDRP. aeruginosa.The extract isolated fromA. verahas antibacterial activity against all of isolates. Also, 42 (89.4%) isolateswere inhibitedby A. vera gel extract at minimum inhibitory concentration (MIC) ≤ 200 𝜇g/mL. MIC value of A. vera gel for other isolates (10.6%)was 800 𝜇g/mL. All of MDR P. aeruginosa strains were inhibited by A. vera at similar MIC

50and MIC

90200 𝜇g/mL. Conclusion.

Based on our results, A. vera gel at various concentrations can be used as an effective antibacterial agent in order to prevent woundinfection caused by P. aeruginosa.

1. Introduction

Pseudomonas aeruginosa (P. aeruginosa) is increasingly rec-ognized as one of the important nosocomial pathogensleading to severe infections especially in hospitalized patientsin burn wards [1]. This opportunistic and highly resistantpathogen is responsible for a variety of nosocomial infec-tions, including urinary or wound infections, bacteremia,endocarditis, and in some conditions death. P. aeruginosainfections in immunocompromised, debilitated patients, cys-tic fibrosis, and hospitalized burn patients are associatedwith increased rates of mortality and morbidity [1, 2].

The unselective and extensive use of antibiotics is highlyconsidered as the major cause of invasive procedures.Accordingly, development of resistance mechanisms eitherintrinsic or acquired has promoted the rapid developmentof multiple resistances among P. aeruginosa isolates in theclinical settings [2]. The rapid increase of drug resistance inclinical isolates of P. aeruginosa is a growing concern amonghospitalized patients [3, 4]. During the past several decades,several different epidemiological studies indicated that mul-tiple resistances among P. aeruginosa clinical isolates areincreasing [5]. The widespread multidrug-resistant (MDR)P. aeruginosa strains not only lead to increased economic

Hindawi Publishing CorporationChemotherapy Research and PracticeVolume 2015, Article ID 639806, 5 pageshttp://dx.doi.org/10.1155/2015/639806

2 Chemotherapy Research and Practice

burden, but also can directly threaten the life of the patient.Ciprofloxacin, gentamycin, and imipenem are routinely usedfor treatment of the P. aeruginosa burn wound infectionsin Iran. Recently, overusing of imipenem in comparisonwith fluoroquinolones, beta lactams, and aminoglycoside,due to their resistance, demonstrated a risk of resistantto this antibiotic in P. aeruginosa isolated from burnedpatients [1]. Nowadays, multiple resistance mechanisms ofP. aeruginosa isolates present serious therapeutic challengesfor treatment [6]. Although antibiotics are routinely used forprevention of the P. aeruginosa burn wound infections, dueto widespread MDR among P. aeruginosa strains leading totherapeutic failures, they are not recommended for regularprevention of burn wound infections associated with thebacteria [1–3]. The use of newer antibiotics, moist exposuretherapy, mafenide acetate, antimicrobial peptides, and acti-coat AB dressing (high-density polyethylene mesh coatedwith nanocrystalline silver) could be used for treatmentof wound infected with MDR P. aeruginosa [1]. Gener-ally, therapeutic strategies should be revised to control P.aeruginosa infections with emphasis on the use of extractand biologically active compounds isolated from the herbalplants. During the past several decades, many studies bothin vivo and in vitro have demonstrated antibacterial activitiesof medicinal plants. According to estimates by World HealthOrganization (WHO), in developing countries, about 80%of the population mainly relies on traditional therapies anduse of plant extracts as the main medicinal source to treatvarious infectious diseases [7, 8]. In the recent years, extractsor oils of medicinal plants with antimicrobial and anti-inflammatory effects have been used for treatment of manyhuman infectious diseases. Aloe vera (A. vera) is one of thesewell-known medicinal plants [9]. A. vera is a cactus-likeperennial, drought resistant, succulent plant belonging to theLiliaceae family, of which there are over 360 known species.The elongated and pointed leaves of plant contain two distinctproducts: yellow latex (exudate) and clear mucilaginous gel(A. vera gel). A. vera gel is revealed after removal of thethick outer cuticle [10]. The gel consists of 99.3% water andthe remaining 0.7% containing a range of active compoundsincluding polysaccharides, vitamins, amino acids, phenoliccompounds, and organic acids [11]. Overall, more than 75active ingredients have been identified from the inner gel[12]. A. vera was first used in the 1930s to heal radiationburns [13]. To date, there are many reports of its beneficialproperties in human, so that it is used for pharmaceutical,food, and cosmetic industries. A. vera gel has been usedin gastrointestinal disorders, sunburn, and wounds sinceancient times. Furthermore, various in vitro and in vivostudies onA. vera have demonstrated that it possesses severalbiological activities, such as anti-inflammatory, antioxidant,immune modulating, and cell growth stimulatory activity aswell as antibacterial, antiviral, and antifungal properties [14].

Although antimicrobial properties of A. vera gel areprimarily recognized, there is still little information on theuses of it and it needs to be more evaluated. The purpose ofthis study was to investigate the in vitro antimicrobial activityof A. vera gel against MDR P. aeruginosa isolated from burnwound infections.

2. Materials and Methods

2.1. Bacterial Strains. The present descriptive study wasperformed on burn cases that were hospitalized in a hos-pital in Tehran, Iran. A total of 140 clinical isolates of P.aeruginosawere collected fromNovember 2014 to April 2015.Nonduplicate isolates were obtained from the burn woundspecimens.The identification of isolateswas carried out basedon standard microbiological procedures such as Gram stain,catalase test, oxidase test, ornithine decarboxylase, argininedihydrolase, growth at 42∘C, growth on Cetrimide agarmedium (Liofilchem, Italy), O/F (Oxidation-Fermentation)test, and pigment production [16]. The confirmed strainsisolated as P. aeruginosa were then stored at −70∘C in TrypticSoy Broth (TSB) (Merck, Germany) containing 20% (v/v)glycerol for further investigation.

2.2. Preparation of A. vera Gel. The plant of A. vera (leaves)was harvested from a local farm in the south Iran in January2015. The plant was identified in the Research Center ofMedicinal Plants. The collected mature and fresh leaves of A.vera were thoroughly washed with sterile distilled water toremove dirt and their thick epidermidis was then dissectedlongitudinally into pieces. The colourless parenchymatoustissue (aloe gel) was collected in a sterile container. Onehundred grams of the gel was mixed in one liter of 2%dimethyl sulfoxide (DMSO) and kept at 4∘C, being used as astock solution forMinimum Inhibitory Concentration (MIC)assay.

2.3. Minimum Inhibitory Concentration (MIC) Assay

2.3.1. MIC of Synthetic Antibiotics. The antimicrobial suscep-tibility test of isolates was determined by estimating MIC ofthe 3 antibiotics usingmicrobroth dilutionmethod accordingto the Clinical Laboratory and Standards Institute (CLSI,2012) guidelines [15].TheMIC was defined as the lowest con-centration of an antimicrobial agent that will inhibit the visi-ble growth of the tested isolate.MIC

50was defined as theMIC

required to inhibit the growth of 50%of organisms andMIC90

was defined as theMIC required to inhibit the growth of 90%of organisms.The following antimicrobial agentswere used inthis study: imipenem, gentamicin, and ciprofloxacin (Sigma-Aldrich, St. Louis, Mo). The concentrations range of the usedantimicrobial agents was, respectively, imipenem from 0.5 to32 𝜇g/mL; gentamicin from 1 to 64, and ciprofloxacin from0.5 to 16 𝜇g/mL.The breakpoints for different antibiotics wereas follows: imipenem 8 𝜇g/mL, gentamicin 16𝜇g/mL, andciprofloxacin 4 𝜇g/mL. P. aeruginosa ATCC 27853 was usedas the control strain for antimicrobial susceptibility test.

2.3.2. MIC of Aloe vera Gel. In order to determine the MICof A. vera gel against P. aeruginosa isolated from burnedpatients, broth microdilution method was carried out in 96-well cell culture plates. In brief, the bacterial suspensions ofthe clinical isolates were obtained from overnight cultures.The turbidity of each bacterial suspensionwas adjusted equiv-alent to a number 0.5 McFarland standard (approximately 1.0× 108 CFU/mL). This suspension was further diluted 1 : 100

Chemotherapy Research and Practice 3

Table 1: Summary of the antibacterial activities of A. vera gel and antimicrobial agents against clinical isolates of P. aeruginosa.

Agent MIC (𝜇g/mL) Number (%) of isolatesMIC

interpretivebreakpointsa

Range 50% 90% S I R S I RAloe vera gel 25–800 200 200 — — —Ciprofloxacin 0.5–16 4 8 33 (23.6) 5 (3.6) 102 (72.8) ≤1 2 ≥4Gentamicin 1–64 8 32 61 (43.6) 5 (3.6) 74 (52.8) ≤4 8 ≥16Imipenem 0.5–32 4 16 70 (50) 4 (2.9) 66 (47.1) ≤2 4 ≥8aMIC breakpoints applied were those recommended for P. aeruginosa by the Clinical and Laboratory Standards Institute (CLSI) [15].

(106 CFU/mL) in the broth media. Twofold dilutions of theA. vera gel stock solution were prepared in the appropriatebroth culture media. Aliquots (200 𝜇L) of each dilution (25,50, 100, 200, 400, and 800 𝜇g/mL) were dispensed in 96-wellcell culture plates. One hundred microliters of each bacterialsuspension was added to each well and incubated at 37∘Covernight. Wells with DMSO (sterility control) and bacterialsuspension (drug-free control) were also used as controls [17].To estimate MIC of A. vera gel, the absorbance of each wellwas measured at 595 nm. MIC level was defined as the lowestconcentration at which no growth was observed.

2.4. Statistical Analysis. Statistical analysis was performedusing SPSS software for Windows, version 17.0 (SPSS Inc.,Chicago, IL).

3. Results

3.1. Antibacterial Activity of Antimicrobial Agents. Duringthe 6-month study period, 140 P. aeruginosa isolates wererecovered from hospitalized burns patients. Of the 140isolates included in the study, 98 isolates (70%) had beenisolated from males and 42 isolates (30%) had been isolatedfrom females. The median age was 46.4 years with an agerange from 5-month to 69-year old. The result of the antimi-crobial susceptibility testing for 140 P. aeruginosa clinicalisolates using microdilution method for three antibioticstested revealed that resistance to ciprofloxacin was in 102(72.8%), to imipenem was in 66 (47.1%), and to gentamicinwas in 74 (52.8%) isolates. Resistance rates varied amongP. aeruginosa clinical isolates from 47.1% for imipenem to72.8% for ciprofloxacin. MDR was defined as resistance to2 or more antibiotics [4]. Forty-seven isolates (33.6%) werecharacterized as the MDR P. aeruginosa strains.

3.2. Antibacterial Activity of Aloe vera Gel. The resultsobtained about antibacterial activities of A. vera gel showedthat all of MDR P. aeruginosa strains except five of them wereinhibited byA. vera gel extract atMIC≤ 400 𝜇g/mL.TheMICvalues of A. vera gel for the remaining five (10.6%) isolateswere 800 𝜇g/mL. Undiluted A. vera gel exhibited inhibitoryeffect on all of MDR isolates. None of the MDR isolates weresensitive to dilutions of A. vera gel less than 25 𝜇g/mL. Invitro susceptibility of the MDR P. aeruginosa strains to threeantibiotics was performed and A. vera gel with the range ofMIC50and MIC

90are summarized in Table 1.

4. Discussion

In the our study, all of MDR P. aeruginosa strains (except fiveof them) were found to be sensitive to A. vera gel extractat MIC ≤ 400 𝜇g/mL. Also, the data obtained in this studyshowed a good antibacterial activity of A. vera gel extract indifferent concentration against MDR P. aeruginosa isolatedfrom burned patients despite many published reports inthis regard. These controversial results could be attributedto difference in susceptibility testing method, difference inextraction process, stresses heat imposed on the gel, and thenumber of pharmacologically active compounds includinganthraquinones, anthracene, anthranol, aloin, aloe mannan,aloetic acid, aloe emodin, aloeride, chrysophanic acid, resis-tanol, and saponin [18, 19].

Many medicinal plants as potential source of novelantimicrobial compounds, A. vera being the most importantone, are widely used by large proportion of the Iranianpopulation for treating burnwound infections [20–22].Theseresults regarding antibacterial activity are in conformitywith earlier findings of Antonisamy et al. who found variedantibacterial antifungal activity of DMSO gel extracts ofA. vera against five bacterial cultures of Bacillus subtilis,Salmonella typhi, Escherichia coli, and Staphylococcus aureusand three fungal cultures of Aspergillus fumigatus, Candidaalbicans, and Penicillium sps. The results showed that DMSOgel extracts of A. vera had highest degree of activity againstthe selected pathogens and the degree of inhibition varieddepending upon the concentration of the extract [23–26].Scientific evidences have proven that the constituents of geland leaf are distinct from each other. Some of investigatorsbelieve that the gel is more active than the leaf, but one clearfeature is that the gel and leaf can complement one anotherin their medicinal capabilities [27]. Surprisingly, there arecontradictory studies about inhibitory effect of gel, leaf, andjuice ofA. vera. In 2010, Anderl et al. showed that both gel andleaf inhibited the growth of S. aureus isolated from woundinfection while the gel has no effect on P. aeruginosa isolates[28].

Several studies exhibited higher level of antibacterialactivity of A. vera gel against fungi strains [29]. Agarry et al.conducted a study to compare the antimicrobial activities ofthe gel and leaf of A. vera against P. aeruginosa, S. aureus,Microsporum canis, Trichophyton schoenleinii, T. mentagro-phytes, and C. albicans. The results presented the significantantibacterial activity of both the gel and the leaf against

4 Chemotherapy Research and Practice

S. aureus. The leaf possesses inhibitory effects on both P.aeruginosa and C. albicans while only the gel inhibited thegrowth of T. mentagrophytes [27]. Investigation of antimi-crobial activities and MIC of A. vera gel and Aloe vera juicein the study of Kaithwas et al. in 2008 clearly demonstratedthat A. vera juice has higher and broader spectrum ofantimicrobial activity than A. vera gel [30]. This difference inactivity of the juice as compared to gel could be attributedto presence of greater amount of the anthraquinones andphenolic antioxidants in the A. vera juice.

There are differences in the antimicrobial effects ofvarious extracts of A. vera. Irshad et al. showed the A. veraextract of Methanol had the maximum antibacterial activityas compared to other solvents, ethanol, and distilled water[31]. The study of Ibrahim et al. in 2011, in order to inves-tigate phytochemical analysis and antimicrobial evaluationof A. vera gel against some human and plant pathogens bydisc diffusion method, was done with three different forms(ethanol, acetone, and aqueous extracts). The antibacterialand antifungal activity of the acetone extract was found to bemore effective than ethanol and aqueous extracts [32]. Pandeyand Mishra reported that there was no inhibitory effect ofaqueous extract on the Gram negative bacteria and weakinhibitory effect on Gram positive bacteria [33]. Differencesin the antimicrobial effects of various extracts of A. veramaybe attributed to different solubility of various compoundsfound in A. vera, particularly, some solvents that have aspecific antifungal or antimicrobial activity.

Although known ingredients in the A. vera leaf gel areobviously present in small mounts (about 1%), they can belinked to work together and create synergistic effect so thatthe total effect is greater than what would be expected fromthe individual effect of each substance [34–36].

5. Conclusion

Our study supports the view that A. vera gel could beactive against P. aeruginosa in wound infections at variousconcentrations and the use of it at optimum concentrationscan help better therapy of many microbial diseases. Furtherinvestigations are required to identify bioactive componentsof A. vera gel and its effect on wide range of bacteria andfungus including the pathogenic strains. It is hoped that thisstudy would lead to the development of aloe gel usage as amain medicinal source to treat various infectious diseases.

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper.

Acknowledgment

The authors appreciate the cooperation of the staff of Micro-biology Department, Shahid Beheshti University of MedicalSciences.

References

[1] A. Japoni, S. Farshad, and A. Alborzi, “Pseudomonas aerug-inosa: burn infection, treatment and antibacterial resistance,”

Iranian Red Crescent Medical Journal, vol. 11, no. 3, pp. 244–253,2009.

[2] A. A. El Solh and A. Alhajhusain, “Update on the treatment ofPseudomonas aeruginosa pneumonia,” Journal of AntimicrobialChemotherapy, vol. 64, no. 2, Article ID dkp201, pp. 229–238,2009.

[3] J. A. Driscoll, S. L. Brody, and M. H. Kollef, “The epidemiology,pathogenesis and treatment of Pseudomonas aeruginosa infec-tions,” Drugs, vol. 67, no. 3, pp. 351–368, 2007.

[4] J.-I. Sekiguchi, T. Asagi, T. Miyoshi-Akiyama et al., “Outbreaksof multidrug-resistant Pseudomonas aeruginosa in communityhospitals in Japan,” Journal of Clinical Microbiology, vol. 45, no.3, pp. 979–989, 2007.

[5] O. Lomovskaya, M. S. Warren, A. Lee et al., “Identificationand characterization of inhibitors of multidrug resistance effluxpumps in Pseudomonas aeruginosa: novel agents for combina-tion therapy,” Antimicrobial Agents and Chemotherapy, vol. 45,no. 1, pp. 105–116, 2001.

[6] J. Chen, Z. Su, Y. Liu et al., “Identification and characterizationof class 1 integrons among Pseudomonas aeruginosa isolatesfrom patients in Zhenjiang, China,” International Journal ofInfectious Diseases, vol. 13, no. 6, pp. 717–721, 2009.

[7] O. Akerele, “WHO guidelines for the assessment of herbalmedicines,” Fitoterapia, vol. 63, no. 2, pp. 99–104, 1992.

[8] K. Oluyemisi Folashade, E. Henry Omoregie, and A. PeterOchogu, “Standardization of herbal medicines—a review,”International Journal of Biodiversity andConservation, vol. 4, no.3, pp. 101–112, 2012.

[9] S. Thiruppathi, V. Ramasubramanian, T. Sivakumar, and V.Thirumalai Arasu, “Antimicrobial activity of Aloe vera (L.)Burm. f. against pathogenic microorganisms,” The Journal ofBiosciences Research, vol. 1, no. 4, pp. 251–258, 2010.

[10] A. Surjushe, R. Vasani, and D. Saple, “Aloe vera: a short review,”Indian Journal of Dermatology, vol. 53, no. 4, pp. 163–166, 2008.

[11] F. Nejatzadeh-Barandozi, “Antibacterial activities and antioxi-dant capacity of Aloe vera,” Organic and Medicinal ChemistryLetters, vol. 3, no. 5, pp. 1–8, 2013.

[12] S. A. Hashemi, S. A.Madani, and S. Abediankenari, “The reviewon properties of Aloe Vera in healing of cutaneous wounds,”BioMed Research International, vol. 2015, Article ID 714216, 6pages, 2015.

[13] T. Reynolds and A. C. Dweck, “Aloe vera leaf gel: a reviewupdate,” Journal of Ethnopharmacology, vol. 68, no. 1–3, pp. 3–37,1999.

[14] S. Satish, D. C. Mohana, M. P. Ranhavendra et al., “Antifungalactivity of some plant extracts against important seed bornepathogens of Aspergillus sp.,” International Journal of Agricul-tural Technology, vol. 3, no. 1, pp. 109–119, 2007.

[15] Clinical and Laboratory Standards Institute, Performance Stan-dards for Antimicrobial Susceptibility Testing: Twenty SecondInformational Supplement, M100-S20, CLSI, Wayne, Pa, USA,2012.

[16] W. C. Winn and E. W. Koneman, Koneman’s Color Atlas andTextbook of Diagnostic Microbiology, Lippincott Williams &Wilkins, 2006.

[17] M. Fani and J. Kohanteb, “Inhibitory activity of Aloe vera gelon some clinically isolated cariogenic and periodontopathicbacteria,” Journal of Oral Science, vol. 54, no. 1, pp. 15–21, 2012.

[18] O. Rosca-Casian,M. Parvu, L. Vlase, andM. Tamas, “Antifungalactivity of Aloe vera leaves,” Fitoterapia, vol. 78, no. 3, pp. 219–222, 2007.

Chemotherapy Research and Practice 5

[19] Y. Ni, D. Turner, K. M. Yates, and I. Tizard, “Isolation andcharacterization of structural components of Aloe vera L. leafpulp,” International Immunopharmacology, vol. 4, no. 14, pp.1745–1755, 2004.

[20] T. A. Hema, A. S. Arya, S. Suseelan, R. K. John Celestinal, andP. V. Divya, “Antimicrobial activity of five South Indian medic-inal plants against clinical pathogens,” International Journal ofPharma and Bio Sciences, vol. 4, no. 1, pp. 70–80, 2013.

[21] G. S. Prashar P, V. Koul, and S. Sehgal, “In vitro antimicrobialactivity of ethanolic extract of Aloe vera against some bacterialand fungal species,” Advanced Biotechnology, vol. 11, no. 3, pp.32–33, 2011.

[22] S. Alemdar and S. Agaoglu, “Investigation of in vitro antimicro-bial activity ofAloe vera juice,” Journal of Animal and VeterinaryAdvances, vol. 8, no. 1, pp. 99–102, 2009.

[23] M. Chinedu Stanley, O. Emmanuel Ifeanyi, and O. GodsonEziokwu, “Antimicrobial effects of Aloe vera on some humanpathogens,” International Journal of Current Microbiology andApplied Sciences, vol. 3, no. 3, pp. 1022–1028, 2014.

[24] V. G. Manikandan and M. H. Muhammad Ilyas, “Analysis ofphytochemical constituents and antibacterial activities of Aloevera L. against some selected pathogens,” International Journalof Biology, Pharmacy and Allied Sciences, vol. 3, no. 1, pp. 56–62,2014.

[25] S. R. Shilpakala, J. Prathiba, and R. Malathi, “Susceptibilities ofEscherichia coli and Staphylococcus aureus to Aloe barbadensis,”European Review for Medical and Pharmacological Sciences, vol.13, no. 6, pp. 461–464, 2009.

[26] J. M. A. Antonisamy, N. Beaulah, R. Laju et al., “Anti-bacterialand antigungal activity of Aloe vera gel extract,” InternationalJournal of Biomedical and Advance Research, vol. 3, no. 3, pp.184–187, 2012.

[27] O. O. Agarry, M. T. Olaleye, and C. O. Bello-Michael, “Compar-ative antimicrobial activities of aloe vera gel and leaf,” AfricanJournal of Biotechnology, vol. 4, no. 12, pp. 1413–1414, 2005.

[28] J. N. Anderl, M. J. Franklin, and P. S. Stewart, “Role of antibioticpenetration limitation in Klebsiella pneumoniae biofilm resis-tance to ampicillin and ciprofloxacin,”Antimicrobial Agents andChemotherapy, vol. 44, no. 7, pp. 1818–1824, 2010.

[29] S. Manipal, F. Shireen, and D. Prabu, “Anti-fungal activity ofAloe vera: In vitro stud,” SRM Journal of Research in DentalSciences, vol. 6, no. 2, pp. 92–95, 2015.

[30] G. Kaithwas, A. Kumar, H. Pandey et al., “Investigation ofcomparative antimicrobial activity of Aloe vera gel and juice,”Pharmacologyonline, vol. 1, pp. 239–243, 2008.

[31] S. Irshad,M.Butt, andH.Younus, “In-vitro antibacterial activityof Aloe barbadensis Miller (Aloe vera),” International ResearchJournal of Pharmaceuticals, vol. 1, pp. 60–65, 2011.

[32] M. Ibrahim, M. Srinivas, and M. Lakshmi Narasu, “Phyto-chemical analysis and antimicrobial evaluation of Aloe vera gelagainst some human and plant pathogens,” Asian Journal ofCurrent Chemistry, vol. 1, no. 1, pp. 1–11, 2011.

[33] R. Pandey and A. Mishra, “Antibacterial activities of crudeextract of Aloe barbadensis to clinically isolated bacterialpathogens,” Applied Biochemistry and Biotechnology, vol. 160,no. 5, pp. 1356–1361, 2010.

[34] S. Subramanian, D. S. Kumar, P. Arulselvan, andG. P. Senthilku-mar, “In vitro antibacterial and antifungal activities of ethanolicextract of Aloe vera leaf gel,” Journal of Plant Sciences, vol. 1, no.4, pp. 348–355, 2006.

[35] M. H. Radha and N. P. Laxmipriya, “Evaluation of biologicalproperties and clinical effectiveness of Aloe vera: a systematicreview,” Journal of Traditional and Complementary Medicine,vol. 5, no. 1, pp. 21–26, 2015.

[36] L. Cellini, S. Di Bartolomeo, E. Di Campli, S. Genovese, M.Locatelli, and M. Di Giulio, “In vitro activity of aloe vera innergel againstHelicobacter pylori strains,” Letters in Applied Micro-biology, vol. 59, no. 1, pp. 43–48, 2014.

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